Humana: The Growth of Value-Based Medicine

“Having practiced for 20 years, I am sympathetic to doctors’ complaints because each health plan seems to be doing something different from the standpoint of collecting data on quality," said Humana’s Chief Medical Officer Dr. Roy Beveridge.

Managed Care is taking a look at the 25-year anniversary of the Healthcare Effectiveness Data and Information Set (HEDIS), noting that more than 90 percent of managed care plans now use HEDIS to collect information on the performance of their physicians in 81 areas of care delivery and service.

HEDIS “is still criticized for focusing on process and taking up doctors’ time,” the publication notes. “But it has been incorporated into physicians’ workflow and may yet be instrumental in bringing about value-based care.”

Humana’s Chief Medical Officer, Dr. Roy Beveridge, was quoted, saying, “Having practiced for 20 years, I am sympathetic to doctors’ complaints because each health plan seems to be doing something different from the standpoint of collecting data on quality. We’re taking time from providers that they should be spending with their patients.”

But the story noted that HEDIS is likely here to stay. “HEDIS scores work well, particularly for primary care,” Dr. Beveridge said. “They’re universally accepted in the United States.”

The story also cited Humana research that “compared 1.2 million members under value-based Medicare Advantage (MA) contracts to 170,000 members under standard MA contracts. The HEDIS scores for the providers associated with the value-based contracts were 19% higher than those associated with the standard contracts. Members served by value-based MA providers had 6% fewer ER visits than members in standard MA arrangements and also had higher breast cancer screening rates (6% higher), colon cancer screening rates (8% higher), and management of osteoporosis (13% higher).”

Managed Care also reported (on pages 4 and 5 of this link) on Humana’s efforts to streamline and standardize the list of quality metrics to minimize the burden on physicians and make it easier for them to report results. “The company last month implemented a Clinical Quality Metrics Alignment program (CQMA), which sliced the insurer’s quality metrics from 1,116 down to 208, more than an 80% reduction,” the story said.

“Humana did this by collecting the 1,116 quality metrics from 29 different data sources across the company. Officials vetted the metrics for inconsistencies, duplication, and clinical relevance. Company officials streamlined the metrics with an eye on the health insurance industry’s efforts to standardize measures used to evaluate clinical quality.”

In a related news release, Dr. Beveridge said, “At Humana, we are committed to helping physicians succeed in their transition from fee-for-service to value-based care. Metrics that are not connected to patient health can serve as obstacles in their transition and distract from the intent of care tied to quality. Through our CQMA program, we hope to greatly simplify quality reporting and alleviate physician burdens.”